People who died in the community make up more than 40% of new cases since the beginning of the year.
At the epicentre of the epidemic in Katwa and Butembo, 43% of patients in the last three weeks had no known links to other infected patients.
“We have a striking contradiction: on the one hand a rapid and large outbreak response with new medical tools such as vaccines and treatments that show promising outcomes when people come early - and on the other hand, people with Ebola are dying in their communities, and do not trust the Ebola response enough to come forward,” said International President of MSF, Dr. Joanne Liu.
Last week, MSF suspended its Ebola activities in Katwa and Butembo, in North Kivu province, after successive attacks on two treatment centres. While MSF does not know the motives or identities of the attackers, these incidents follow an escalation of tensions around the Ebola response.
Dozens of security incidents occurred against the Ebola response as a whole in February alone. While the causes of these incidents are not all the same, it is clear that various political, social and economic grievances are increasingly crystalizing around the response.
A range of issues have led to these tensions: from the massive deployment of financial resources focusing only on Ebola in a neglected region suffering from conflict, violence and long-standing health needs; to elections being officially postponed due to the Ebola outbreak, exacerbating suspicions that Ebola is a political ploy.
The use of police and armed forces to compel people to comply with health measures against Ebola is leading to further alienation of the community and is counterproductive to controlling the epidemic. Using coercion for activities such as safe burials, tracking of contacts and admission into treatment centres discourages people from coming forward and pushes them into hiding.
The Ebola response must take a new turn. Choices on how to manage the disease must be given back to patients and their families. Vaccination for Ebola must reach more people, and more vaccines are needed for this. Communities have other dire health needs that should be addressed. And coercion must not be used as a tactic to track and treat patients, enforce safe burials or decontaminate homes.
“Ebola is a brutal disease, bringing fear and isolation to patients, families and health care providers,” said Dr. Joanne Liu. “The Ebola response needs to become patient- and community-centered. Patients must be treated as patients, and not as some kind of biothreat.”
Seven months since the beginning of the current Ebola outbreak in the provinces of North Kivu and Ituri, there have been 907 cases of Ebola cases (841 confirmed and 66 probable) and 569 people have died. [source: World Health Organization (WHO) report week 9]
MSF has suspended its activities in Katwa and Butembo, but maintained its Ebola-related activities in the North Kivu towns of Kayna and Lubéru, as well as its management of two Ebola transit facilities in Ituri province, in the towns of Bwanasura and Bunia. In the city of Goma, MSF has been supporting emergency preparedness by reinforcing the surveillance system and ensuring there is adequate capacity to manage suspected cases.
Three MSF staff have been missing for almost six years after being abducted in Kamango, Nord Kivu, where they were carrying out a health assessment on 11 July 2013. MSF continues to search for them.